Is Pain Colorblind?

Is Pain Colorblind?

A growing body of research says that if pain is colorblind, people and their perceptions of it certainly aren’t.

A new study found that mostly white children as young as 7 reported that they believed black children felt less pain than the black children actually did, a trend in bias that did not decrease as the children got older.

The study at the University of Virginia asked children at the ages of 5, 7, and 10 to rate the severity of pain felt by other children when they hit their head or had their hand slammed in a door. The children rated other children of their same gender.

The 7- and 10-year-olds rated the pain felt by black children as less severe than the pain felt by white children. The study does not explore why children felt this way. Participants were primarily white, so it did not investigate if children of other races had the same response. Rebecca Dore, Ph.D. candidate and lead investigator had this to say:

“Our finding can’t speak to how parents or teachers, for example, might intervene and try to halt these biases at an early age, but we currently are running a study that might speak to that question. However, what this study can inform is the timing of any interventions. If we want to prevent this bias from developing, it needs to be done by age 7, or age 10 at the latest.”

In general, when people witness others experiencing pain, their brains react in much the same way as if they were experiencing the pain themselves. Not true for participants in the study who admitted racial bias.

Conducted in Italy, the study showed participants films of people undergoing painful stimuli, monitoring the participants’ responses. In cases where bias existed, there was no empathetic response. Researchers also found something else interesting: participants did experience an empathetic response when the person feeling pain was tinted a violet color.

“This is quite important because it suggests that humans tend to empathize by default unless prejudice is at play,” said Salvatore Maria Aglioti of Sapienza Università di Roma.

When examining other research on older adults regarding racial differences in pain diagnosis and treatment, a pattern emerges that builds on the lack of empathy and need for early intervention.

Even when reporting higher pain scores, studies show that minorities are given opioid analgesics at a lower rate than whites.

A study in 1994 indicated that this disparate treatment of pain was not for lack of diagnosis. Looking at emergency room statistics for Hispanic and non-Hispanic patients, researchers found that the diagnosis of pain was equal between the 2 groups, while prescription analgesic use was not.

The study authors commented that:

“…the unequal use of analgesics we observed in our original study is not explained by physicians’ inability to assess the pain experience of Hispanic patients, assuming that physicians in this study do not behave in a fundamentally different way from the very similar group of physicians whose behavior was the subject of the previous study. Another possible explanation of the discrepant treatment pattern is straightforward bias by physicians who are equally aware of pain in both ethnic groups, but less interested in treating it when patients are Hispanic.”

But this was 1994, and physicians have come a long way since then, right? More recent research suggests that they have not. In 2013 In the Face of Pain, an online pain advocacy group created and supported by Perdue Pharma L.P., published a paper that examined disparities in pain diagnosis and treatment.

They found that disparities in diagnosis and treatment had to do with a combination of factors that include:

Race

Ethnicity

Socioeconomic class

Cultural attitudes towards pain

Access to adequate healthcare

These factors spill over from diagnosis and treatment and into monitoring of pain treatment. Lead investigator Leslie R.M. Hausmann, PhD at the Center for Health Equity Research and Promotion in the VA Pittsburgh Healthcare System and assistant professor of medicine at the University of Pittsburgh, looked at the electronic records of 1,646 white patients and 253 black patients who filled prescriptions for pain that was unrelated to cancer.

Although there were differences in some characteristics (e.g., white patients were older and more likely to be married), there was no difference in their history of substance abuse. However, researchers found that black patients were more likely to be tested for drug levels than white patients, even though pain levels were taken for black patients less frequently.

Additionally, black patients were less likely to be recommended to a pain specialist but more likely to be referred for substance abuse assessment. Dr. Hausmann concludes that:

“The emerging picture is that black patients who are able to overcome the barriers to securing a prescription for opioid medications may still be subjected to differential monitoring and follow-up treatment practices that could impact the effectiveness of their pain management. Addressing disparities in opioid monitoring practices may be a previously neglected route to reducing racial disparities in pain management.”